Sub-Saharan Africa accounts for approximately 10% of the world's population, but is home to approximately 70% of the 2.7 million people estimated to be newly infected with HIV worldwide annually, and 35% of the estimated 8.8 million new tuberculosis (TB) cases. The burden of HIV and TB in Africa is reflected in higher rates of both infections in African emigrants to other countries when compared to their local counterparts. The goal of this career development award is to gain expertise in TB epidemiology and control, and research methodologies that will broaden my abilities to address HIV, TB, and other health issues in the African population in the US. My longer-term career objective is to improve the overall health of this population through both research and public health practice. The proposed research addresses questions crucial to the development of effective HIV and TB prevention and control programs for the African-born population. The specific aims of the proposal are to: 1) Estimate the extent to which transmission of HIV and TB occurs prior to arrival in the US among African-born persons, identify barriers to HIV testing and missed opportunities for HIV diagnoses among African-born US residents, and define the potential risk of ongoing HIV and TB transmission both within and outside of the African-born community; 2) Evaluate missed opportunities for TB screening and diagnosis, describe delays in diagnosis of active TB in the African population compared to non-Africans, and estimate the prevalence of TB genotypes typically seen in African- born patients in non-African populations; and 3) Develop projections for the size and composition of the African-born HIV and TB epidemics in the US over the next 20 years, using a combination of demographic and dynamic epidemic modeling. The career development component of the application is designed to augment my existing skills in the areas of HIV and STD epidemiologic research. The proposed educational aims will allow me to build skills in four specific areas necessary to carry out my research aims, and include training in: 1) TB epidemiology and control, 2) Demography and mathematical modeling, 3) Immigration and health. The unparalleled training environment at the University of Washington (UW), the close and collaborative relationships between the UW and the HIV/STD and TB Programs of Public Health - Seattle and King County, and the exceptional team of mentors and advisors that will supervise my training and research will further contribute to my career development and transition into a successful independent investigator. PUBLIC HEALTH RELEVANCE STATEMENT (provided by applicant): The proposed research will examine HIV and tuberculosis (TB) among African people living in the US, a population at high risk for both infections. Data on how much HIV transmission occurs before arrival in the US, missed opportunities for HIV and TB screening, and how many new HIV and TB infections we can expect among this population will be essential to guide control programs and reduce transmission of these infections both within the African community, and from this community to other populations.